the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Friday, April 22, 2011

tongue twister

in the old days at kalafong (hell) we sometimes had to deal with obnoxious people. alcohol tends to make the worst of a personality come to the fore. most of us tended to ignore these irritations and get on with the job, but there were exceptions.

he was a senior registrar at the time. before going into the whole surgery thing he had been in the army and had served in the angolan war in the special forces. i occasionally asked him about those days, but he never spoke about it. i think it messed him up a bit and he probably didn't want to dwell on that stage of his life too much. only once did he ever actually say anything to me that alluded to what he had gone through.

"bongi, when you are in battle and people are shooting at you with the intention of killing you, it somehow changes your perspective on life." i suppose part of his changed perspective was that he tended not to take crap from mere mortals (hy vat nie kak van kabouters nie), especially those with more than a liberal dose of dutch courage.

the patient was drunk beyond description. he lay there in casualties with a nice neat bullet hole through his chest. however the injury had done nothing to his foul mouth. he maintained a constant stream of verbal abuse directed against anyone and everyone who had anything to do with him. when the poor house doctor inserted the intercostal drain she had to contend with both his sharp tongue as well as the occasional flying fist. he even managed to land a blow which had reduced the house doctor to tears. to her credit, she had continued the procedure but was unwilling to go near him after that. she called her senior, the registrar, to make sure the patient had no other injuries.

my friend walked into casualties, quickly found out what the trouble was about and approached the patient. he stood just outside the reach of the patient and casually observed his fists flying around, keeping everyone away. he listened as the patient flung a stream of obscenities at him. he seemed unmoved, but the wry smile that until then had been on his face slowly slipped away to be replaced by a stern grimace. he tried to speak to the patient to explain that he needed to check him out but this was met with such aggression that he ended up walking away. the house doctor tried once more to approach the patient, but caught a heavy body blow and slumped to the floor in pain. that, it seemed, was too much for the registrar.

"sister, put the patient in the procedure room. i'll be back in five minutes."

five minutes later the registrar returned. he went straight to the procedure room. just before he entered he turned to the sister.

"sister, call the maxillofacial surgeon and tell him we have a patient for him with a broken jaw."

"does the patient have a broken jaw?" she asked, surprised.

"well not yet." and with that he entered the room and closed the door.

after that, so the story goes, the patient was as tame as a lamb, albeit a lamb with a very swollen face.

lynda, i thought the americans already tried that and it didn't work. not that i am qualified to give an opinion, but i don't think alcohol is evil or wrong in itself. excess is. likewise, food causing obesity doesn't mean food in itself is wrong.

michkhoo, i think education of that order in this country is nothing but a pipe dream. i simply don't see it happening here. i don't even expect it.

lost soul, you are the only one who has commented on the actual issue. thank you. however i'm not sure i agree with you. true i often wish i could orientate a patient with a stiff clout, but violence begets violence. vicious circle and all. put it like this, i don't necessarily agree with the management of my friend, but that doesn't mean i didn't get a good laugh. sometimes i dream about klapping (south african word meaning hitting, usually with open hand) a patient or two, but it isn't right to actually do it. it's probably not wrong to secretly be delighted that someone else did, though.

While not condoning the registrar's actions I can understand the build up of frustration that led to it. How you guys (doctors, nurses, medical providers in general) deal with this kind of abuse while still providing care if beyond my capabilities.

I was gonna say something along the lines of 'please tell me this story is real, and if so, good for him!' but then I realised something I think most people forgot- the guy was drunk. Whilst that is no excuse as it was his choice to drink in the first place, it means that hopefully there's a slight chance that he's not as voilent or as foul-mouthed in 'real life'. But to be honest I doubt this is the case...

A good friend was working in an ED in a foreign country when an obnoxious drunk came in with a chest injury. He swore and spat at the staff. My mate recognised his accent as South African, so he went up to the patient and wispered in his ear "Do you know were I'm from? I'm South African!" with that his patient (and countryman) shut up. And lay silently without flinching while my mate put in a chest drain without anaesthetic. It seems this story of the broken jaw reached the South African expat community in distant lands!

I had to deal with a burly highschool kid who was spaced totally out of his bracket on dagga - on top of the spliff, his 'mates' had fed him a tablespoon full of seeds. It took 4 nurses to eventually hold him down & restrain him. This only happened after the &*()!# slapped me across the boobs, which hurt like hell! I grabbed his 'tackle' & twisted.............feel free to flinch bongi LOL.

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disclaimer

the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.